Do anxiety disorders delay ADHD diagnosis?

PostedNovember 19, 2025

UpdatedNovember 21, 2025

ByMy Patient Advice

Author: Harriet Winslow, BSc | Reviewed by: Dr. Rebecca Fernandez, MBBS

Anxiety disorders often complicate or delay the diagnosis of attention deficit hyperactivity disorder (ADHD). According to NHS guidance on ADHD in children, overlapping symptoms such as restlessness, poor concentration, and worry can mask the underlying signs of ADHD. Recent research, including reviews published in Frontiers in Psychiatry, confirms that anxiety can both mimic and conceal ADHD traits, particularly in adults and women.

How anxiety masks or mimics ADHD

Anxiety can present perfectionism, avoidance, and overthinking, all of which may appear similar to ADHD-related inattention or executive dysfunction. For example, a person who delays tasks due to worry may seem inattentive or disorganised, when in fact the difficulty stems from anxiety rather than ADHD itself. The NICE NG87 guideline on ADHD diagnosis and management warns that anxiety disorders, especially generalised or social anxiety, frequently overlap with ADHD, leading to confusion during assessment and delays in diagnosis.

The role of comorbidity and gender

Comorbidity is common: studies indicate that around 30–50% of adults and up to one-third of children with ADHD also have an anxiety disorder. This overlap makes it harder for clinicians to separate the causes of symptoms. Women and girls, in particular, are more likely to present with anxiety, depression, or perfectionism rather than hyperactivity, which contributes to later ADHD diagnosis or misdiagnosis.

NHS and NICE guidance on accurate assessment

Both the NHS and NICE advise that clinicians take a full psychiatric and developmental history, including information from family, teachers, or partners. The sequence and context of symptoms are crucial whether anxiety developed in response to unmanaged ADHD or exists as a primary condition. Validated tools such as the Conners’ or ASRS for ADHD, alongside GAD-7 for anxiety, are advised to clarify overlapping features.

If severe anxiety is present, NICE recommends stabilising anxiety first and then reassessing ADHD symptoms once emotional distress is reduced. Integrated, multidisciplinary care, and psychoeducation are also essential for clarity and support.

Key takeaway

Anxiety disorders can significantly delay ADHD diagnosis by masking or mimicking symptoms. Following NHS and NICE guidance using comprehensive, gender-aware, and multi-source assessments helps clinicians distinguish between the two and provide timely, effective treatment for both conditions.

Harriet Winslow, BSc

Author

Harriet Winslow is a clinical psychologist with a Bachelor’s in Clinical Psychology and extensive experience in behaviour therapy and developmental disorders. She has worked with children and adolescents with ADHD, autism spectrum disorder (ASD), learning disabilities, and behavioural challenges, providing individual and group therapy using evidence-based approaches such as CBT and DBT. Dr. Winslow has developed and implemented personalised treatment plans, conducted formal and informal assessments, and delivered crisis intervention for clients in need of urgent mental health care. Her expertise spans assessment, treatment planning, and behavioural intervention for both neurodevelopmental and mental health conditions.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the author's privacy.

Dr. Rebecca Fernandez, MBBS

Reviewer

Dr. Rebecca Fernandez is a UK-trained physician with an MBBS and experience in general surgery, cardiology, internal medicine, gynecology, intensive care, and emergency medicine. She has managed critically ill patients, stabilised acute trauma cases, and provided comprehensive inpatient and outpatient care. In psychiatry, Dr. Fernandez has worked with psychotic, mood, anxiety, and substance use disorders, applying evidence-based approaches such as CBT, ACT, and mindfulness-based therapies. Her skills span patient assessment, treatment planning, and the integration of digital health solutions to support mental well-being.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the reviewer's privacy.